In 2006, the Bureau of Labor reported that 60% of workplace assaults occurred in healthcare, and most of the assaults were committed by patients. Healthcare support occupations had an injury rate of 20.4 per 10,000 workers due to assaults, and healthcare practitioners had a rate of 6.1 per 10,000;this compares to the general sector rate of only 2.1 per 10,000. As significant as these numbers are the actual number of incidents is much higher due to the gross underreporting in healthcare that is related to the perception that assaults are part of the job. Recent evidence indicates that nurses and other direct care providers who work in emergency departments (EDs) are at greater risk of violence than other providers. Although there are numerous epidemiological studies that have emphasized that ED violence is a prevalent and serious problem, there are no published accounts of interventions to reduce this alarming trend. The purpose of this intervention study is to partner with six hospitals to test a multi-dimensional intervention to prevent assaults against ED workers and reduce the related negative consequences. Primary study aims are to test the effectiveness of an intervention to: 1) reduce assaults against ED workers from patients and visitors, 2) decrease acute stress disorder symptoms, absences, and loss of productivity after assaults and physical threats, and 3) increase employees'feelings of safety and self-confidence in managing aggressive patients and visitors. Secondary study aims are to: 1) develop and implement processes and procedures for ensuring the intervention is planned with stakeholder input and involvement, and 2) develop and implement processes that increase the capacity of the EDs to sustain the intervention. The EDs will be randomly assigned as an intervention or control site. The intervention was developed using the Haddon Matrix, violence research, and feedback from ED managers. All ED employees who provide direct care at the six hospitals will be invited to participate in the study. Data on assaults, physical threats, stress, and productivity will be collected for nine months before and nine months after implementation of the program. The Diffusion of Innovations Theory will be used to plan, implement, evaluate and sustain the intervention. Focus groups with ED employees, managers and patients will be conducted to obtain information that will guide the implementation of the intervention. The research methods will include strategies that focus on fostering collaborations among the participating EDs and among the researchers, practitioners, and employees. In addition to having experienced violence researchers, this interdisciplinary team also includes an ED physician and nurses who have working relationships with key players in our partnering EDs. The proposed research is essential to advance progress in the field of violence in the healthcare sector and could serve as a model for EDs as well as high risk settings such as psychiatric, long-term care, and critical care units. PUBLIC HEALTH RELEVANCE: Emergency Departments (EDs) are becoming dangerous work settings for employees due to the increased violence from patients and visitors. There are no published accounts of strategies that will reduce this alarming trend. This study will test an intervention that could improve the work conditions for over 1 million ED healthcare workers and improve the care for millions of patients who visit EDs each year.